Tonsillitis

Topic Overview

What is tonsillitis?

Tonsillitis is an infection
or inflammation of the
tonsils. The tonsils are balls of
lymph tissue on both sides of the throat, above
and behind the tongue. They are part of the
immune system, which helps the body fight
infection.

Tonsillitis often goes away on its own after 4 to 10
days.

What causes tonsillitis?

Most often, tonsillitis
is caused by a virus. Less often, it is caused by the same bacteria that cause
strep throat. In rare cases, a fungus or a parasite
can cause it.

Tonsillitis is spread through the air in droplets
when an infected person breathes, coughs, or sneezes. You may then become
infected after breathing in these droplets or getting them on your skin or on
objects that come in contact with your mouth, nose, or eyes.

What are the symptoms?

The main symptom of
tonsillitis is a sore throat. The throat and
tonsils usually look red and swollen. The tonsils may
have spots on them or pus that covers them completely or in patches. Fever is
also common.

If you feel like you have a cold, with symptoms such
as runny and stuffy nose, sneezing, and coughing, a virus is most likely the
cause.

If you have a sore throat plus a sudden and severe fever
and swollen lymph nodes, but you do not have symptoms of a
cold, the infection is more likely caused by bacteria. This means you need to
see a doctor and probably need a strep test.

How is tonsillitis diagnosed?

Your doctor will
look at your throat to see if you have
red and swollen tonsils with spots or sores. These signs can mean you have
tonsillitis.

Your doctor may do a rapid strep test along with a
throat culture. These will show whether the tonsillitis is caused by
streptococcus bacteria.

Your doctor may also ask about past throat
infections. If you get tonsillitis often, it may affect the choice of
treatment.

You may have a test for
mononucleosis if your doctor thinks that you have
mono.

How is it treated?

Tonsillitis caused by a virus
will usually go away on its own. Treatment focuses on helping you feel better.
You may be able to ease throat pain if you drink warm
tea, take over-the-counter pain medicine, and use other home treatments. Do not give aspirin to
anyone age 20 or younger. It is linked to a serious disease called
Reye syndrome.

If your tonsillitis is
caused by strep, you need treatment with antibiotics. Antibiotics can help
prevent rare but serious problems caused by strep and can control the spread of
infection.

As a rule, doctors only advise surgery to remove
tonsils (tonsillectomy) when there are serious problems with the tonsils. These
include infections that happen again and again or long-lasting infections that
do not get better after treatment and get in the way of daily activities. You
and your doctor can decide if surgery is the right choice after a careful
review of your or your child's overall health.

Cause

Tonsillitis is usually caused by a
virus. Bacteria can also cause tonsillitis. The most common bacterial cause of
tonsillitis is group A beta-hemolytic streptococcus (GABHS), which also causes
strep throat.

Tonsillitis can also be
caused by fungi or parasites. But these causes are rare in people who have
healthy
immune systems.

How tonsillitis is spread

Tonsillitis is spread by
close contact with an infected person. Droplets of disease-causing agents
(pathogens) pass through the air when an infected
person breathes, coughs, or sneezes. You may then become infected after
you breathe in these droplets. Infection can also occur if pathogens get on your skin or on objects that come in contact with your mouth, nose, eyes, or other
mucous membranes. Symptoms usually appear about 2 to 5 days after exposure.

A person with tonsillitis caused by strep bacteria is contagious
early on and, without treatment, can remain so for up to 2 weeks. Antibiotics
shorten the contagious period, and an infected person is no longer contagious
about 24 to 48 hours after beginning antibiotic therapy.

Symptoms

The main symptom of
tonsillitis is a sore throat. More symptoms occur in
most cases. Some or all of the following may be present:

When you have sore throat plus cold symptoms such as nasal
congestion, runny nose, sneezing, and coughing, the cause is most likely a
virus. Viral infection of the tonsils usually goes away without treatment
within 2 weeks.

Sore throat with, swollen glands, a sudden fever above
101°F (38.3°C), and without symptoms of an upper respiratory tract infection may point to a bacterial infection like strep that needs to be treated with antibiotics.

What Happens

Tonsillitis, in most cases, lasts 4 to 10 days. A bacterial sore throat may last slightly longer but usually gets better with antibiotics.

In some cases, tonsillitis can
become chronic. Surgical removal of the tonsils (tonsillectomy) may be
recommended for you or your child based on past health and results of physical
exams.

Complications of tonsillitis

Tonsillitis caused
by strep bacteria that is not treated with antibiotics may result in
complications, such as ear and sinus infections or
pockets of infection outside the tonsils (peritonsillar abscess). More serious
complications, such as
rheumatic fever, are rare.

Recurrent and ongoing (chronic) tonsillitis may obstruct the upper airway
and cause problems, such as snoring, nasal congestion, and mouth breathing.
Sometimes chronic tonsillitis can lead to more severe conditions, including
obstructive sleep apnea and heart and lung problems.
But most children who have sleep apnea and enlarged tonsils do not have a history
of tonsillitis.

What Increases Your Risk

Close contact with an infected
person is the main risk factor for
tonsillitis. Droplets of disease-causing agents (pathogens) pass through the air when an infected
person breathes, coughs, or sneezes. You may then become infected after
breathing in these droplets. Infection can also occur if pathogens get on your
skin or on objects that come in contact with the mouth, nose, eyes, or other
mucous membranes.

Nasal obstruction causes you to breathe through
your mouth, which increases the risk of tonsillitis.

When To Call a Doctor

Call your doctor if any of the
following occur.

Sore throat, along with any two of these signs
of bacterial infection:

Watchful waiting

Watchful waiting is a period of time during
which you and your doctor observe your or your child's symptoms or condition
without using medical treatment. Watchful waiting is appropriate if tonsillitis
occurs along with cold symptoms such as runny nose, nasal congestion, sneezing,
and coughing. Tonsillitis with these symptoms is most often caused by a virus.
Viral infection of the tonsils can be treated at home and in most cases goes away
without treatment within 2 weeks. In general, the more like a cold the
condition is, the less likely it is that the condition is caused by strep
bacteria.

Watchful waiting is not appropriate if tonsillitis
occurs with a fever of
101°F (38.3°C) or higher or
with swollen lymph nodes in the neck, and without symptoms of an
upper respiratory tract infection. If these symptoms
occur together, see a doctor. You may have strep throat, which should be
treated promptly.

Exams and Tests

Diagnosis of
tonsillitis is based on a medical history and a
physical exam of the throat. An accurate medical history is needed to find out whether tonsillitis is recurrent, which may affect treatment
choices.

If your symptoms suggest
strep throat, your doctor may want to confirm this
diagnosis by doing a
throat culture. Strep throat is more likely if 3 or 4
of the following signs or symptoms are present:

Fever

White or yellow spots or
coating on the throat and/or tonsils (tonsillar exudates)

Swollen
or tender lymph nodes on the neck

Absence of coughing or
sneezing

If a strep infection is suspected, your doctor may do a
rapid strep test or a
throat culture or both. Both of these tests can be
done in a doctor's office. You may want to discuss the
advantages and disadvantages of each test to see which
test is appropriate.

The results of these tests will determine
whether antibiotic treatment is needed. These results combined with an accurate
medical history will be considered in deciding whether surgery to remove the
tonsils (tonsillectomy) is recommended.

If the Epstein-Barr
virus, which can cause
mononucleosis, is suspected as a cause for the
tonsillitis, a
test for mononucleosis may be done.

Treatment Overview

Tonsillitis is
most often caused by a virus, which resolves on its own. But tonsillitis can be
caused by strep bacteria, which requires treatment with antibiotics. Watch for
signs of dehydration, such as a dry mouth and tongue.
Also, watch for signs of
complications, such as ear pain, from tonsillitis
caused by strep bacteria.

Tonsillitis caused by a virus

Tonsillitis caused
by a virus will usually go away on its own. Antibiotics are not effective
treatment for viral tonsillitis.

The virus that causes
mononucleosis (mono) can lead to tonsillitis that is
as severe as tonsillitis caused by bacteria and can take several weeks or more
before it goes away.

Home treatments such as drinking warm tea and taking over-the-counter pain medicine (such as acetaminophen or ibuprofen) may help relieve discomfort. Do not give aspirin to anyone younger than 20 because of its link to
Reye syndrome, a serious but rare problem.

Many nonprescription remedies such as antiseptic mouthwashes,
decongestants, and
antihistamines contain extra ingredients that don't
relieve discomfort. These remedies are not recommended for children, because
they have not been proved to have any benefits in the treatment of acute
tonsillitis.1

Tonsillitis caused by bacteria

Antibiotics are
prescribed for tonsillitis caused by strep bacteria. A strep infection
will usually go away on its own, but antibiotic treatment is needed because
untreated
strep throat can cause serious
complications. For more information, see the topic
Strep Throat.

If antibiotics are
prescribed, be sure you take them exactly as directed by your
doctor. Antibiotics should be taken for the entire duration of the
prescription, even if the symptoms disappear completely before the prescription
is gone. If antibiotics used to treat tonsillitis are not taken as directed,
bacteria can become resistant to them (antibiotic resistance). In these cases, antibiotic treatment of future infections
may not work.

Surgery

Surgical removal of the tonsils
(tonsillectomy) is still a common procedure, particularly for children. But it is
not done nearly as often as it was in the past. Tonsillectomy may be
considered to treat tonsillitis when a child has serious complications,
recurrent infections, or chronic infections that do not respond to treatment
and interfere with daily functioning. But the risks and benefits of surgery
need to be weighed carefully. Tonsillectomy should only be done after you
and your doctor carefully consider your or your child's overall health.

Prevention

A wide variety of viruses and bacteria can
cause
tonsillitis, so the best prevention is to follow basic
health and hygiene precautions. These steps are especially helpful for
children:

Avoid close contact with others who are sick. If possible, keep your child away from children who are known to
have tonsillitis or a sore throat.

Often remind your child about
the importance of proper
hand-washing, especially when around people who appear
to be sick. Also tell your child not to share toothbrushes or eating utensils with
other children.

Teach children to cover their mouths when coughing or sneezing,
preferably using a tissue so that germs do not get on their hands. Also show
them how to use tissues to wipe their noses.

Carry disposable wipes and a hand sanitizer to clean hands and
to wipe off shopping carts or other shared items in public places.

Do not smoke around your child.

Home Treatment

The goal of home treatment of
tonsillitis caused by a virus is to manage symptoms as
the body fights off the infection. Home treatment eases the discomfort
of sore throat and symptoms such as runny nose, nasal congestion,
sneezing, and coughing.

Things that may help you or your child
feel better include:

Gargling often with warm salt water if your child is age 8 or older. You can make your own salt water by mixing 1 tsp (5 g) salt with 8 fl oz (240 mL) warm water.

Taking over-the-counter pain medicines (such as
acetaminophen or ibuprofen) to help relieve sore throat pain. Be safe with medicines. Read and follow all instructions on the label. If you give medicine to your baby, follow your doctor's advice about what amount to give. Do not give aspirin to anyone
younger than 20 because of its link to
Reye syndrome, a serious but rare problem.

Using throat lozenges to help relieve sore throat
symptoms. But lozenges should not be given to young children because of the
risk of choking. Also, many lozenges contain unneeded ingredients that can
be potentially harmful.

Cough and cold medicines may not be safe for young children or for people who have certain health problems. Before you use these medicines, check the label. Many over-the-counter remedies,
including antiseptic mouthwashes,
decongestants, and
antihistamines, contain extra ingredients that don't
relieve discomfort. These remedies are not recommended for children, as these
ingredients have not been proved to have any benefits in the treatment of acute
tonsillitis.1

A sore throat along with sudden fever and
swollen lymph nodes, and without symptoms of an
upper respiratory tract infection, may point to a
bacterial infection. Anyone with these symptoms should see a doctor to be
tested for
strep throat, which requires treatment with
antibiotics. It is important to get plenty of rest and take all the prescribed
antibiotics exactly as directed. Keep your child home from school for the first
1 to 2 days of antibiotic treatment. He or she is still contagious during this
time and might pass the infection to others.

Medications

Tonsillitis is
usually caused by a virus and does not require prescription medicine. For information on over-the-counter pain medicine and other self-care options, see Home Treatment.

An
antibiotic, usually amoxicillin or penicillin, is used to treat
tonsillitis caused by strep bacteria. Although tonsillitis caused
by strep bacteria usually will go away on its own, antibiotics are used to
prevent the
complications, such as
rheumatic fever, that can result from untreated
strep throat.

What to think about

If antibiotics are prescribed, be sure you take them
exactly as directed by your doctor until the medicine is gone. Even if the
symptoms go away completely before the prescription is gone, all pills should
be taken as directed to make sure the infection is completely destroyed.
Bacteria can become resistant to the antibiotics used to treat tonsillitis
(antibiotic resistance) if prescriptions aren't taken
as directed or if they are prescribed when they aren't needed.

Surgery

Tonsillectomy for
tonsillitis is generally used for children who have
serious complications or recurrent infections that do not respond to other
treatment, especially when they interfere with daily life. But
tonsillectomy should only be done after you and your doctor
carefully consider your child's medical history and overall health.

Researchers in a recent study concluded that tonsillectomy may be no
better than watchful waiting for children who have mild symptoms, which was defined
as tonsillitis occurring fewer than 3 times a year.2

But for some children, tonsillectomy can greatly improve their
quality of life. Children who are most likely to benefit from tonsillectomy are
those who have:

7 or more episodes of tonsillitis in 1 year, or 5 or more episodes a year for the past 2 years, or 3 or more episodes a year for the past 3 years.
Tonsillectomy is more likely to be considered as treatment when some of these
episodes result in missing school, trouble sleeping, or having other problems with
normal daily life.2

Tonsillitis lasting longer than 3 months,
despite medicine.

Obstructed air passages.

Difficulty
swallowing.

Difficulty talking because of nasal
obstruction.

Tonsils that bleed heavily.

Surgery choices

Tonsillectomy for strep throat may be
done in cases of recurring tonsillitis that do not respond to antibiotics or if
an infection threatens the child's well-being.

What to think about

Tonsillectomy is still the most
common major surgical procedure done on children in the United States. But it
is not done as often as it was in the past.

Upper respiratory
infections and tonsillitis usually occur less frequently as a child gets
older. Consider whether your child's tonsillitis
infections are manageable until you can wait to see if he or she outgrows them.

A child who has tonsillectomy will need special care and close
monitoring for at least a week after the surgery. Consider your ability to
provide this care for your child before deciding on tonsillectomy.

Other Places To Get Help

Organizations

HealthyChildren.org

141 Northwest Point Boulevard

Elk Grove Village, IL 60007

Phone:

(847) 434-4000

Web Address:

www.healthychildren.org

This American Academy of Pediatrics website has information for parents about childhood issues, from before the child is born to young adulthood. You'll find information on child growth and development, immunizations, safety, health issues, behavior, and much more.

American Academy of Otolaryngology—Head and Neck Surgery
(AAO-HNS)

1650 Diagonal Road

Alexandria, VA 22314-2857

Phone:

(703) 836-4444

Web Address:

www.entnet.org

The American Academy of Otolaryngology—Head and Neck
Surgery (AAO-HNS) is the world's largest organization of physicians dedicated
to the care of ear, nose, and throat (ENT) disorders. Its Web site includes
information for the general public on ENT disorders.

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use.
How this information was developed to help you make better health decisions.